Ⅱ期高血压病高胰岛素血症对血液粘度及血脂的影响

以２１例Ⅱ期高血压患者、２１例Ⅱ期高血压病高胰岛素血症患者及２０例正常人为研究对象，以全血比粘度、全血还原比粘度、血浆比粘度、红细胞压积及血浆甘油三酯、总胆固醇、高密度脂蛋白为指标；结果表明Ⅱ期高血压病患者全血比粘度、全血还原比粘度较正常人高，Ⅱ期高血压病高胰岛素血症患者亦较单纯高血压病患者进一步增高，同时其血浆甘油三酯较单纯高血压病患者增高，高密度脂蛋白降低．而血浆比粘度、红细胞压积、总胆固醇三组间无显著性差异。单纯高血压病患者与正常人组比较血脂无差异。因而认为高血压病患者的高胰岛素血症可使高血压病患者增高的血粘度进一步增高，且血粘度的增高主要是红细胞机能、代谢的改变所致。单纯高血压病患者血脂改变不明显，高血压病患者血脂的改变主要是由高胰岛素血症所致。     

Adult hyperinsulinemic hypoglycemia not caused by an insulinoma: a report of two cases

Nesidioblastosis is rare in adults and accounts for 0.5–5% of cases of organic hyperinsulinemia. The diagnosis of nesidioblastosis should be considered when peroperative imaging modalities fail to localize a lesion in patients with hyperinsulinism. Two female patients, aged 55 and 16 years, with hyperinsulinemic hypoglycemia are reported. Somatostatin receptor scintigraphy showed slight focal activity in both patients. The first patient underwent a Whipple procedure and became diabetic. The second patient underwent a distal hemi-pancreatectomy and suffered from recurrent hypoglycemic episodes 3 months after surgery, for which she is presently being treated with octreotide. Histological examination of the resected pancreata revealed focally increased islet tissue and a number of slightly hypertrophic beta cells. Such histological abnormalities have been related to functional changes of β-cells. In infantile nesidioblastosis, a proportion of cases has been associated with mutations in one of several genes. Whether such mutations, leading to hyperinsulinism, also play a role in adult nesidioblastosis is presently unknown. Received: 5 July 1999 / Accepted: 19 January 2000     

Insulinemic and Inflammatory Dietary Patterns and Risk of Prostate Cancer

BackgroundHyperinsulinemia and inflammation are inter-related pathways that link diet with the risk of several chronic diseases. Evidence suggests that these pathways may also increase prostate cancer risk.ObjectiveTo determine whether hyperinsulinemic diet and inflammatory diet are associated with prostate cancer incidence and mortality.Design, setting, and participantsWe prospectively followed 41 209 men in the Health Professionals Follow-up Study (1986–2014). Scores for two validated dietary patterns were calculated from food frequency questionnaires at baseline and updated every 4 yr.Outcome measurements and statistical analysisTotal, advanced, and lethal prostate cancer outcomes were assessed. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were determined for associations between two empirical hypothesis-oriented dietary patterns—empirical dietary index for hyperinsulinemia and empirical dietary inflammatory pattern—and prostate cancer risk estimated using Cox proportional hazard regression.Results and limitationsDuring 28 yr of follow-up, 5929 incident cases of total prostate cancer, including 1019 advanced and 667 fatal, were documented. In multivariable-adjusted models, there was a 7% higher risk of advanced prostate cancer (HR: 1.07; 95% CI: 1.01–1.15) and a 9% higher risk of fatal prostate cancer (HR: 1.09; 95% CI: 1.00–1.18) per standard deviation (SD) increase in the hyperinsulinemic diet. When stratified by age, the hyperinsulinemic diet was associated with only earlier-onset aggressive prostate cancer (men under 65 yr), with per SD HRs of 1.20 (95% CI: 1.06–1.35) for advanced, 1.22 (1.04–1.42) for fatal, and 1.20 (1.04–1.38) for lethal. The inflammatory diet was not associated with prostate cancer risk in the overall study population, but was associated with earlier-onset lethal prostate cancer (per SD increase HR: 1.16; 95% CI: 1.00–1.35).ConclusionsHyperinsulinemia and inflammation may be potential mechanisms linking dietary patterns with the risk of aggressive prostate cancer, particularly earlier-onset disease.Patient summaryAvoiding inflammatory and hyperinsulinemic dietary patterns may be beneficial for the prevention of clinically relevant prostate cancer, especially among younger men.     

Die Kombinationstherapie Insulin/Sulfonylharnstoff in der Langzeittherapie des Typ-II-Diabetes nach „Sekundärversagen“

Summary In type 2 diabetes with secondary failure of sulfonylurea therapy good metabolic control can seldom be achieved by insulin therapy even with high insulin doses. Hyperinsulinemia however is a possible risk factor of cardiovascular disease in type 2 diabetes. Maintaining the effects of sulfonylurea action insulin should be added in as small amounts as possible to avoid hyperinsulinemia and to ameliorate hyperglycemia.16 type 2 diabetics with secondary failure were treated either with insulin alone (group A;n=8) or with 3.5 mg b.i.d glibenclamide plus small amounts of intermediate insulin (group B;n=8) in a randomised order. After the inpatient period outpatient control was performed monthly up to six months, later on four times a year up to two years.Both groups were comparable with regard to age, duration of diabetes, body weight and metabolic control. The daily insulin dose was 14±2 IU after one month and 19±2 IU after two years in group B. In contrast 30±3 IU and 43±5 IU respectively were needed in group A (p<0.001). All patients B were treated with one daily injection, all patients A needed two injections. Resulting in nearly identical metabolic control in group A basal insulin levels exceeded those in group B after two years significantly (28.6±3.7 vs. 18.6±1.6 mcU/ml;p<0.01). Endogenous C-peptide response was suppressed in group A compared to group B after inpatient period and after one month (0.12±0.01 vs. 0.49±0.15 and 0.09±0.04 vs. 0.13±0.08 pmol/ml;p<0.05). The combined therapy of insulin and sulfonylureas demonstrates the benefit of a prolonged sulfonylurea administration in the treatment of type 2 diabetes with secondary failure.As compared to common insulin therapy a small amount of exogenous insulin by one daily injection additionally to glibenclamide shows similar improvement in metabolic control. Hyperinsulinemia as a risk factor of macroangiopathy is markedly reduced in patients treated with combined therapy compared to those with insulin alone.

Herrn Professor Dr. N. Zöllner zum 65. Geburtstag gewidmet     

二甲双胍治疗多囊卵巢综合征的临床研究

目的:探讨二甲双胍在治疗多囊卵巢综合征的临床效果。方法:30例多囊卵巢综合征(PCOS)患者,口服二甲双胍12周,采取自身对照,观察用药前、后临床症状、血清卵泡刺激素(FSH)、黄体生成激素(LH)、睾酮(T)、雄烯二酮(A2)、空腹血糖及空腹胰岛素水平的变化。结果:继发闭经13例中,7例恢复有排卵月经;月经稀发17例,10例恢复有排卵月经,不孕症16例,用药期间妊娠4例。用药后两组空腹胰岛素和雄激素水平均降低,比较差异有显著性(P<0.05)。结论:二甲双胍可有效改善PCOS患者的胰岛素抵抗状态,降低血中雄激素水平并恢复生育功能。     

Could serum levels of irisin be used in gestational diabetes predicting?

ObjectiveGestational diabetes mellitus (GDM) is a metabolic disorder during pregnancy leading to acute and chronic complications in both mother and newborn. The pathogenesis of GDM has not been fully understood, However, since the disease shares risk factors with type 2 diabetes mellitus (T2DM), a relationship between these two disease states is plausible. The recently discovered peptide irisin has been hypothesized to be a regulator of body metabolism. However, studies ended up with controversial results. In the present study, we aimed to investigate the relationship between irisin levels and gestational diabetes mellitus and the possible benefits of the metabolic profile.Materials and methodsWe performed a cross-sectional analysis of circulating levels of irisin in 100 pregnant women similar for age and body mass index and the groups included 50 gestational diabetic patients and 50 healthy pregnant volunteers. Serum irisin levels were measured by ELISA kit.ResultsMean age and body mass index levels were similar in both groups. Median HbA1c, fasting blood glucose, Glucose 1 h, Glucose 2 h and fasting insülin levels were higher in with gestational diabetic patients compared to the control group. In gestational diabetic group, the median irisin level was lower than in the control group.ConclusionSerum irisin levels were lower in gestational diabetic patients. Further investigations are needed to explore the underlying biological effects of irisin on pregnant women.     

肥胖症伴阻塞性睡眠呼吸暂停与胰岛素抵抗及高胰岛素血症的关系

目的 探讨肥胖症伴阻塞性睡眠呼吸暂停（OSA）与胰岛素抵抗（IR）及高胰岛素血症（HI）的关系。方法 选择诊断为肥胖症伴OSA综合征（OSAS）患者60例和正常对照组20名行多导睡眠图检查和胰岛素敏感指数（ISI）、空腹胰岛素（FINS）、空腹血糖（FPG）、空腹C肽（FCP）、HbA1c及血清总胆固醇（TC），甘油三酯（TG)，高密度脂蛋白胆固醇（HDL－C)测定。结果 （1）OSAS组的FPG、HbA1c、FINS、FCP、TC、TG水平均明显高于正常组，且OSAS病情越重，轻、中、重度组间差别也越显著，而重度OSAS组HDL－C则较正常组明显降低。（2）ISI与睡眠呼吸暂停低通气指数（AHI）、经皮血氧饱和度（SpO2)降低大于4％的总次数、SpO2低于90％的时间呈显著负相关，而与入睡前SpO2的基础值、睡眠中SpO2最低值、SpO2平均值呈显著正相关。FINS则与AHI、SpO2降低大于4％的总次数、SpO2低于90％的时间呈显著正相关，而与入睡前SpO2的基础值、睡眠中SpO2最低值、SpO2平均值呈显著负相关。多元逐步回归分析结果表明：AHI为ISI与FINS的第2位独立决定因子，其作用仅次于体重指数。结论 OSA可独立肥胖、年龄等混淆因素，与IR与HI间存在独立相关关系。AHI、呼吸暂停持续时间及SpO2降低的程度是导致OSA患者血糖增高，血脂异常（特别是高TG血症）发生的重要的因素。     

罗格列酮对2型糖尿病合并高血压患者血压的作用

目的：运用胰岛素增敏剂罗格列酮治疗2型糖尿病伴高血压患者，研究其降压作用及降压机理。方法：38例2型糖尿病伴高血压患者，口服罗格列酮（文迪雅）4～8mg／d，共12周，观察治疗前后的血压、瘦素、血糖和胰岛素水平，计算胰岛素敏感指数和胰岛素抵抗指数，并进行分析比较。结果：罗格列酮治疗后收缩压和舒张压明显下降（P〈0．05）；甘油三酯（TG）、空腹血糖（FBG）、餐后血糖（PBG）、空腹胰岛素（FINS）和餐后胰岛素（PINS）均明显降低（P均〈0．05）；瘦素水平明显升高（P〈0．01）；胰岛素敏感性指数（ISI）显著升高（P〈0．05），胰岛素抵抗指数（IR）显著下降（P〈0．05）。结论：罗格列酮在降低血糖、改善胰岛索抵抗、提高胰岛素敏感指数的同时，具有升高瘦素水平和降低血压的作用。     

老年高血压患者胰岛素抵抗与左室结构改变的关系

目的探讨老年原发性高血压患者胰岛素抵抗（IR）在高血压发生、发展过程中对左室结构的影响。方法72例高血压患肯依照左室质量指数（LVMI）和相对室壁厚度（RWT）分为左室正常构型组（34例）、向心性重构组（18例）、向心性肥厚组（11例）、离心性肥厚组（9例），并行口服葡萄糖耐量试验（OGTT）加同步胰岛素释放试验，计算胰岛素敏感性指数（ISI）、血糖曲线下面积（AG）、胰岛素曲线下面积（AI）、空腹血胰岛素/空腹血糖（FSI／FSG）比值、AI／AG比值。设健康对照组35例。应用单元和多元回归分析观察RWT和LVMI与各胰岛素敏感性指标的关系。结果高血压组的RWT与FSI、FSG无关（P〉0．05），与AI、AG呈正相关（r值分别为0．160、0．227，P〈0．05），与ISI呈负相关（r值为=0．266，P〈0．01）；LVMI与各胰岛素敏感性指标无相关性（P〉0．05）。逐步回归分析显示RWT与ISI呈独立相关（r^2=0．071、P〈0．05）。结论高胰岛素血症（HIS）及IR存在于老年高血压患者各种左室几何构型中，其中与向心性重构关系最密切，与IR相关的HIS是参与和促进左心室向心性重构的重要影响因素。     

多囊卵巢综合征患者发生妊娠期糖尿病危险因素分析

目的了解多囊卵巢综合征(PCOS)患者发生妊娠期糖尿病(GDM)的危险因素。方法选取2016年2月～2018年8月于我院就诊的PCOS合并GDM患者54例(GDM组)及未合并GDM的PCOS孕妇60例(非GDM组),收集受试者年龄、孕周、孕前BMI、孕前空腹胰岛素、孕前睾酮、孕期增加体重、糖尿病家族史,比较两组间相关指标差异。结果 GDM组孕前BMI、孕前空腹胰岛素、孕前睾酮、孕期增加体重均高于非GDM组(均P0.05)。两组间糖尿病家族史差异缺乏统计学意义(P0.05)。Logistic回归分析提示较高的孕前BMI、孕前空腹胰岛素、孕期增加体重为PCOS患者发生GDM的独立危险因素。结论 PCOS女性孕前适当减重,控制高胰岛素血症,孕期合理控制体重增加,对于预防GDM的发生可能有益。